Cough into your elbow.

Sing happy birthday twice as you wash your hands.

And even if “I never get sick,” vaccinate for influenza in the spirit of “herd immunity.”

Those are flu prevention tips prescribed at Niles-Buchanan Rotary Club Monday noon at Riverfront Café by Yasaman Back, M.S., a Berrien County Health Department epidemiologist, and Jim Rockhill, R.N., C.I.C. (Certification in Infection Control), Lakeland HealthCare, Niles.

Back said flu season arrived a month and a half earlier than usual. It usually lasts until March or April. Vaccine takes two weeks to work once injected.

“We’re seeing widespread activity. That’s where we’re at right now,” said Back, who studied biology at Michigan State University, earning her master’s degree in epidemiology. “Last season (2011-12) was really mild. The year before that (2010-11) was moderate. Right now, we can’t really say where we are because we’re still in it. There have been five flu deaths in Michigan. Everyone should get vaccinated to protect those around you, even if you don’t get sick.”

“The largest numbers we’ve seen were right between Christmas and New Year’s,” Rockhill said. “(Dec. 28 and 29) we saw a lot of activity coming into emergency rooms and through admissions. We’ve seen some tapering of that. There are still some peaks and valleys we’re seeing. There was a major increase just north of us last week. It isn’t too late to be vaccinated.”

Holidays and snow days exacerbate flu.

“When families get together,” confined indoors, “lots of transmission goes on,” Back said. “It peaks around the holidays every flu season.”

Back said flu season arrived a month and a half earlier than usual. It usually lasts until March or April. Vaccine takes two weeks to work once injected.

“We’re seeing widespread activity. That’s where we’re at right now,” she said. “Last season (2011-12) was really mild. The year before that (2010-11) was moderate. Right now, we can’t really say where we are because we’re still in it. There have been five flu deaths in Michigan. Everyone should get vaccinated to protect those around you, even if you don’t get sick.”

An epidemic occurs when new cases of a certain disease in a given human population and during a given period substantially exceed what is expected based on recent experience.

“A pandemic is an epidemic that is very widespread over a larger area,” she said.

Flu is a contagious respiratory illness a virus causes.

Some people refer to stomach problems as “flu,” by it is a respiratory illness with symptoms include fever of 100 degrees Fahrenheit or greater, cough or sore throat, muscle aches, chills and headache and, in some cases, vomiting and/or diarrhea.

Symptoms may begin a few days after exposure to the virus and could last seven days.

Individuals who have flu-like illness should plan on staying home from work and school until 24 hours after their fever is gone without use of fever-reducing medicine, such as Tylenol or Motrin.

Flu spreads by coughing and sneezing or by touching your own eyes, nose and mouth without washing your hands first for as long as it takes to sing happy birthday twice in your head.

Anti-viral drugs can treat flu by shortening its length if given within the first 48 hours.

Call your health care provider if anyone in your home: has difficulty breathing and/or chest pain; is less alert than normal; is vomiting and unable to keep liquids down or is showing signs of dehydration; and has flu-like symptoms that improve, but return with a fever and worse cough.

Vaccination offers the best prevention. Two types are available — FluMist nasal spray, which can be given to healthy peoples ages 2 to 49 years old; and injectable vaccination (shots). Avoid close contact with ill people. Stay home when you are ill to prevent spreading your illness to others.

Cover your nose and mouth when coughing or sneezing. Use a tissue or handkerchief. Dispose of used tissues immediately.

Teach kids to sneeze and cough (droplets travel three to six feet) into their elbow — not their hands to prevent spread of germs. Don’t share anything that goes into the mouth, such as drinking cups, straws and water bottles.

Wash hands after touching anything that could be infected with flu virus.

Keep yourself generally healthy. Eat a diet rich in fruits and vegetables and sleep at least seven to eight hours each night.

Flu vaccine is made each year to protect against three viruses research indicates are most likely to cause illness, including H1N1 (swine flu).

Flu vaccination is recommended every year for everyone six months and older.

“If there’s ever an outbreak of anything,” Back said, “I’m the person who does research and figures out what’s going on. I also do a lot of analysis on health data we gather.”

Rockhill, an infection preventionist, said of “herd immunity,” “It’s not just that we’re protecting ourselves from the flu, but also people who may be too weak and their immune systems may not be capable of generating antibodies from that vaccine. We need enough of a pool — a large percentage of the population — of those who are immunized to prevent weaker people from catching that disease.”